Long term effect of repeated hyperbaric oxygen therapy on visual acuity in inflammatory cystoid macular oedema

Abstract OBJECTIVES Failure of anastomotic healing is a morbid complication after airway or oesophageal surgery. Hyperbaric oxygen therapy (HBOT) has been used extensively in the management of complex wound-healing problems. We demonstrate the use of HBOT to rescue at-risk anastomoses or manage anastomotic failures in thoracic surgery. METHODS Retrospective review of 25 patients who received HBOT as part of the management of tracheal or oesophageal anastomotic problems during 2007–2018. HBOT was delivered at 2 atm with 100% oxygen in 90-min sessions. RESULTS Twenty-three patients underwent airway resection and reconstruction while 2 patients underwent oesophagectomy. There were 16 (70%) laryngotracheal and 7 (30%) tracheal resections. Necrosis at the airway anastomosis was found in 13 (57%) patients, partial dehiscence in 2 (9%) patients and both in 6 (26%) patients. HBOT was prophylactic in 2 (9%) patients. Patients received a median of 9.5 HBOT sessions (interquartile range 5–19 sessions) over a median course of 8 days. The airway anastomosis healed in 20 of 23 (87%) patients. Overall, a satisfactory long-term airway outcome was achieved in 19 (83%) patients; 4 patients failed and required reoperation (2 tracheostomies and 1 T-tube). HBOT was used in 2 patients after oesophagectomy to manage focal necrosis or ischaemia at the anastomosis, with success in 1 patient. Complications from HBOT were infrequent and mild (e.g. ear discomfort). CONCLUSIONS HBOT should be considered as an adjunct in the management of anastomotic problems after airway surgery. It may also play a role after oesophagectomy. Possible mechanisms of action are rapid granulation, early re-epithelialization and angiogenesis.

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Late-stage sequela of an isolated optic neuropathy after acute magnesium valproate overdose: A case report

European Journal of Ophthalmology ◽

10.1177/1120672120974943 ◽

2020 ◽

pp. 112067212097494

Author(s):

Xuhao Chen ◽

Haohao Di ◽

Ying Hong ◽

Chun Zhang

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Hyperbaric Oxygen ◽

Optic Neuropathy ◽

Visual Function ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Early Stage ◽

Systemic Treatments ◽

The Right

Background: Magnesium valproate is a valproic acid (VPA) derivative that is widely used for the treatment of epilepsy and bipolar disorders. Acute overdose of VPA may cause complicated systemic syndromes; however, the reports of ocular sequelae caused by toxic optic neuropathy (TON) are rare. Case presentation: We present a case of a 19-year-old female with bilateral damage to visual function after acute VPA overdose. She was comatose and received systemic treatments for 1 month, during which she suffered a substantial loss of visual function without any evident neurological sequelae. The first recorded visual acuity was no light perception in the right eye (OD) and hand motion in the left eye (OS). Her best-corrected visual acuity improved to 20/100 OS after 4 months of hyperbaric oxygen therapy and neurotrophic treatments. Her visual field was limited to an inferior nasal area OS. Therefore, a diagnosis of TON was made. Her visual function remained stable in the left eye, but did not recover in the right eye during the 5-month follow-up. We found damage to the optic nerve pathway during ophthalmic examinations. Conclusion: We report a rare case of TON caused by acute VPA overdose. Hyperbaric oxygen therapy, and neuroprotective and neurotrophic treatments might be effective at the early stage but cannot fully reverse the damage to the optic nerve. The present case indicates the potential neurotoxicity of VPA. It is crucial to determine the severity of an isolated optic nerve sequela caused by VPA overdose, though it might be rare as observed in previous reports. Further confirmation of the likelihood of its causation and its pathophysiology is needed in the future.

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